Antenatal care coverage and early childhood mortality in Zimbabwe: new interpretations from nationally representative household surveys.

Zimbabwe has implemented universal antenatal care (ANC) policies since 1980 that have significantly contributed to improvements in ANC access and early childhood mortality rates. However, Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), two of Zimbabwe's main sources of health data and evidence, often provide seemingly different estimates of ANC coverage and under-five mortality rates. This creates confusion that can result in disparate policies and practices, with potential negative impacts on mother and child health in Zimbabwe. We conducted a comparability analysis of multiple DHS and MICS datasets to enhance the understanding of point estimates, temporal changes, rural-urban differences and reliability of estimates of ANC coverage and neonatal, infant and under-five mortality rates (NMR, IMR and U5MR, separately) from 2009 to 2019 in Zimbabwe. Our two samples z-tests revealed that both DHS and MICS indicated significant increases in ANC coverage and declines in IMR and U5MR but only from 2009 to 2015. NMR neither increased nor declined from 2009 to 2019. Rural-urban differences were significant for ANC coverage (2009-15 only) but not for NMR, IMR and U5MR. We found that there is a need for more precise DHS and MICS estimates of urban ANC coverage and all estimates of NMR, IMR and U5MR, and that shorter recall periods provide more reliable estimates of ANC coverage in Zimbabwe. Our findings represent new interpretations and clearer insights into progress and gaps around ANC coverage and under-five mortality rates that can inform the development, implementation, monitoring and evaluation of policy and practice responses and further research in Zimbabwe.

Contrasting mental health correlates of physical and sexual abuse-related shame.

OBJECTIVE: This study represents an initial attempt to contrast behavioural and mental health correlates of shame as a result of physical abuse (PA) and sexual abuse (SA). Because they are distinctive forms of injury, it is possible that corollary shame from these injuries follows unique trajectories and ultimately results in different health challenges. METHOD: Self-report data from a survey on the health of youth receiving protective services for reasons of PA and SA was used. It included standardised measures, such as the Childhood Trauma Questionnaire, Trauma Symptoms Checklist for Children, the Brief Symptoms Inventory, the Rutgers Alcohol Problem Index, and the South Oaks Gambling Screen. New measures of abuse-related shame, maltreatment, and substance use were also employed. Linear regression analyses were performed to determine whether level of shame was linked to mental health and behaviour issues, after controlling for level of abuse. RESULTS: Results were similar for shame as a result of PA and SA victimisation. After accounting for shared variance with abuse severity, both measures were linked to a full spectrum of mental health issues, such as depression (SA r2 = 0.30, PA r2 = 0.28), anxiety (SA r2 = 0.27, PA r2 = 0.20), post-traumatic stress (SA r2 = 0.26, PA r2 = 0.19), interpersonal sensitivity (SA r2 = 0.17, PA r2 = 0.22), and psychoticism (SA r2 = 0.19, PA r2 = 0.20), but not to gambling or substance use problems. PA-related shame was associated with suicidality (r2 = 0.05). CONCLUSIONS: Keeping in mind that this was largely a cross-sectional study and that causality cannot be inferred, the results seem to indicate that youth suffering from abuse-related shame are particularly vulnerable to mental health problems, but not to efforts to numb their problematic thoughts and feelings through gambling and substance use. Shame could serve as an early indicator of which child protection recipients are most in need of preventive efforts.

Exploring alternate specifications to explain agency-level effects in placement decisions regarding Aboriginal children: Further analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect Part C.

A series of papers using data from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) explored the influence of clinical and organizational characteristics on the decision to place Aboriginal children in out-of-home placements at the conclusion of child maltreatment investigations. The purpose of this paper is to further explore a consistent finding of the previous analyses: the proportion of investigations involving Aboriginal children at a child welfare agency is associated with placement for all children in that agency. CIS-2008 data were used in the analysis, which allowed for inclusion of previously unavailable organizational and contextual variables. Multi-level statistical models were developed to analyze the influence of clinical and organizational variables on the placement decision. Final models revealed that the proportion of investigations conducted by the child welfare agency involving Aboriginal children was again a key agency-level predictor of the placement decision for any child served by the agency. Specifically, the higher the proportion of investigations of Aboriginal children, the more likely placement was to occur for any child. Further, this analysis demonstrated that structure of governance, an organizational-level variable not available in previous cycles of the CIS, is an important agency-level predictor of out-of-home placement. Further analysis is needed to fully understand individual and organizational level variables that may influence decisions regarding placement of Aboriginal children.

Differentiating between child protection and family support in the Canadian child welfare system's response to intimate partner violence, corporal punishment, and child neglect.

Rates of reported child maltreatment nearly doubled in Canada over the period 1998-2003, an increase that reflects growing awareness of the harmful effects of an expanding array of parental behaviors, including corporal punishment, lack of supervision, and exposure to intimate partner violence (IPV). Some of these situations may benefit from voluntary family support programs outside of the child welfare system. Analyzing a sample of 11,807 investigations, this paper compares cases where the sole concern is exposure to IPV, or hitting a child, or neglect, or other forms of investigated maltreatment. Situations where exposure to IPV or potentially abusive hitting were the sole reason for investigation presented with fewer risk factors and were less likely to lead to ongoing child welfare interventions compared to other maltreatment investigations. While situations involving alleged neglect presented a higher risk profile and elicited a more intensive child welfare response than did exposure to IPV or hitting, opportunities for alternative services were nevertheless identified. The study also found that visible minority families were overrepresented in cases involving hitting and that Aboriginal families were overrepresented in cases involving neglect. Overall the findings support the development of alternative response programs in Canada.

Understanding the investigation-stage overrepresentation of First Nations children in the child welfare system: an analysis of the First Nations component of the Canadian Incidence Study of Reported Child Abuse and Neglect 2008.

OBJECTIVES: The overrepresentation of Aboriginal children in child welfare systems in the U.S., Canada, and Australia is well documented, but limited attention has been paid to investigation-stage disproportionality. This paper examines the overrepresentation of First Nations (the largest of three federally recognized Aboriginal groups in Canada) children, focusing on three questions: (1) What is the level/nature of First Nations overrepresentation at the investigation stage? (2) What is known about the source of referrals in child welfare investigations involving First Nations children? (3) What risk factors and child functioning concerns are identified for investigated First Nations children and families? METHODS: The First Nations Component of the Canadian Incidence Study of Reported Child Abuse and Neglect (FNCIS-2008) was designed to address limitations in existing Aboriginal child welfare data: it sampled one quarter of the Aboriginally governed child welfare agencies that conduct investigations in Canada, gathered data on over 3,000 investigations involving First Nations children, and incorporated weights designed for analysis of First Nations data. Bivariate analyses are used to compare investigations involving First Nations and non-Aboriginal children. RESULTS: The rate of investigations for First Nations children living in the areas served by sampled agencies was 4.2 times that for non-Aboriginal children; investigation-stage overrepresentation was compounded by each short term case disposition examined. A higher proportion of First Nations than non-Aboriginal investigations involved non-professional referrals, a pattern consistent with disparities in access to alternative services. Workers expressed concerns about multiple caregiver risk factor concerns for more than ½ of investigated First Nations families and, with the exception of "health issues", identified every caregiver/household risk factor examined in a greater percentage of First Nations than non-Aboriginal households. CONCLUSIONS: It would be extremely difficult to reduce First Nations overrepresentation at later decision points without addressing overrepresentation at the investigation-stage. Despite the serious needs of investigated First Nations families, alternatives to traditional child protection responses may be appropriate in many cases. If First Nations overrepresentation is to be reduced, child welfare agencies must be equipped to provide supports needed to help families address factors such as poverty, substance abuse, domestic violence, and lack of social supports.